前路病灶清除植骨和后路固定治疗腰骶椎结核

Anterior Radical Focus Debridement with Interbody Autografting and Posterior Internal Fixation to Treat Lower Lumbar and Sacrum Spinal Tuberculosis

目的探讨经腹腔入路一期病灶清除、自体髂骨移植、后路椎弓根固定治疗腰骶椎结核的效果。方法对2004年8月-2007年6月收治12例L4～S1椎体结核,采用经腹腔入路显露腰骶椎,彻底清除病灶后用自体髂骨块椎间植骨,后路椎弓根螺钉固定;术后常规支持和抗结核治疗,术后1、3、6、9、12个月,以后每6个月一次定期随访,观察血沉变化,摄X线片、CT三维重建评估结核活动、骨块融合和畸形矫正情况。结果术中无大血管、神经、输尿管损伤,随访11～23个月,平均17个月,结核病变局部无复发,无结核性腹膜炎、性功能障碍等并发症发生。结论经腹腔前方入路暴露腰骶椎结核病灶充分、安全,病灶清除后行自体髂骨块椎间植骨、腰骶椎后路椎弓根螺钉固定可有效重建腰骶椎的稳定性。

Objective To explore the effect of posterior transpedicular screw fixation,one stage anterior focus debridement and bone grafting for lumbar and sacrum spinal tuberculosis.Methods The lumbosacral junction was exposed adequately via anterior midline transperitoneal approach in 12 patients,radical debridement was performed,then interbody iliac crest bone autografting was placed and posterior pedicle was fixed with screw.All the patients were treated by antituberculous chemotherapy for 12 months after the operation,and followed up regularly in three-month intervals of half a year.The clinical status,erythrocyte sediment rate（ESR）,roentgenogram and 3D-CT were concerned to estimate the progress of tuberculosis.Radiographs were analyzed before surgery,immediately after surgery,and at the final follow-up examination to assess the result of anterior fusion and maintenance of correction.Results There was no injury of blood vessel,ureter or cauda equina during the surgery.The mean follow-up period was 17 months（ranged 11-23 months）,no obvious loss of deformity correction was found in any of these patients.Conclusion The midline transperitoneal approach can provide direct and safe access to the lesions.Management by posterior pedicle vertebral fixation associated with anterior resection plus interbody autografting for lower lumbar segment and lumbar and sacrum spinal tuberculosis is effective to stablize the lumbosacral junction.